Covered Entity Details

CH01058J PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE (Terminated) - information as of 6/7/2025 4:45:16 AM

Main Details

Name

PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE

Subdivision Name

THE METROPOLITAN SHC

Type

HRSA-Funded Health Center

Site ID

BPS-H80-006210

340B ID

CH01058J

Grant Number

H80CS00057

Additional Details

Current Program Status

Terminated

Registration Date

4/1/2004

Participating Start Date

4/1/2004

Participating Approval Date

3/25/2004

Last Recertification Date

2/1/2024

Termination Date
Termination Reason

4/1/2025
Business decision by the Covered Entity

Contacts

Authorizing Official

PCHC
MERRILL THOMAS, CEO
(401) 444-0400 Ext: 3130

Primary Contact

Providence Community Health Centers
Garrett Clark, CO
(401) 444-0400

Addresses

Street Address

325 PUBLIC ST
PROVIDENCE, RI 02905-2340

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
NEW SITE 04/01/2004	04/01/2004

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
RI	601200231	1053313593

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH010580	Active	BPS-H80-002838	PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE	PROVIDENCE COMMUNITY HEALTH CENTERS, INC.	375 Allens Ave	Providence	RI
CH01058A	Active	BPS-H80-011771	PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE	Providence Community Health Center at Prairie Avenue	355 Prairie Ave	Providence	RI
CH01058AA	Approved	BPS-H80-039940	THE PROVIDENCE COMMUNITY HEALTH CENTERS, INC.	Providence Community Health Centers at Broad Street	228 Broad St	Providence	RI
CH01058B	Active	BPS-H80-000453	PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE	Capitol Hill Health Center	40 Candace St	Providence	RI
CH01058C	Active	BPS-H80-001567	PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE	CENTRAL HEALTH CENTER	239 Cranston St	Providence	RI
CH01058D	Active	BPS-H80-002621	PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE	CHAFEE HEALTH CENTER	1 Warren Way	Providence	RI
CH01058G	Active	BPS-H80-002804	PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE	OLNEYVILLE HEALTH CENTER	100 Curtis St	Providence	RI
CH01058J	Terminated	BPS-H80-006210	PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE	THE METROPOLITAN SHC	325 PUBLIC ST	PROVIDENCE	RI
CH01058N	Active	BPS-H80-005125	PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE	Crossroads RI	160 Broad St	Providence	RI
CH01058P	Terminated	BPS-H80-002443	PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE	DENTAL CLINIC	557 Broad St	Providence	RI
CH01058Q	Active	BPS-H80-010568	PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE	Providence Community Health Centers at North Main Street	530 N Main St	Providence	RI
CH01058R	Terminated	BPS-H80-011048	PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE	The Providence Community Health Centers at Chad Brown	285A Chad Brown St	Providence	RI
CH01058S	Active	BPS-H80-014017	PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE	PCHC Dental Tower	335r Prairie Avenue	Providence	RI
CH01058T	Terminated	BPS-H80-020811	PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE	Providence Community Health Centers Annex	9 Warren Way	Providence	RI
CH01058U	Active	BPS-H80-019332	PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE	1 Randall Square Suite 202	1 Randall Square, Suite 202	Provi	RI
CH01058V	Active	BPS-H80-019329	PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE	Randall Square Health Center Suite 205	1 Randall Sq Ste 205	Providence	RI
CH01058W	Active	BPS-H80-031889	Providence Community Health Centers, Inc., The	Randall Sq Specialty Clinic Suite 308	1 Randall Square STE 308	Providence	RI
CH01058X	Active	BPS-H80-031382	Providence Community Health Centers, Inc., The	Providence Community Health Centers at Mt. Pleasant High School	434 Mount Pleasant Ave	Providence	RI
CH01058Y	Active	BPS-H80-031383	Providence Community Health Centers, Inc., The	Providence Community Health Centers at Roger Williams Middle School	278 Thurbers Ave	Providence	RI
CH01058Z	Active	BPS-H80-034053	Providence Community Health Centers, Inc., The	Atwood Street Health Center	31 Atwood St	Providence	RI

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH010580	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2023
CH010580	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2023
CH010580	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2023
CH010580	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2023
CH010580	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/01/2023
CH010580	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2023
CH010580	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/01/2023
CH010580	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	04/01/2019
CH010580	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2019
CH010580	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	04/01/2025
CH010580	ANTHONY DRUG STORES INC		ANTHONYS DRUG 219 MANTON AVE	PROVIDENCE	RI	02909	10/01/2019	08/26/2019
CH010580	ANTHONY'S PHARMACY ATWOOD LLC	1524 ATWOOD AVE STE 114		JOHNSTON	RI	02919	10/01/2024
CH010580	ANTHONYS PHARMACY LLC	219 MANTON AVE		PROVIDENCE	RI	02909	10/01/2019	01/31/2025
CH010580	ASTHENIS	206 CRANSTON ST		PROVIDENCE	RI	02907-2308	07/01/2019
CH010580	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019
CH010580	BIOPLUS SPECIALTY PHARMACY CA	7373 LINCOLN WAY		GARDEN GROVE	CA	92841	04/01/2025
CH010580	BIOPLUS SPECIALTY PHARMACY LA, LLC	2731 MANHATTAN BLVD STE B17		HARVEY	LA	70058	04/01/2025
CH010580	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	04/01/2025
CH010580	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	04/01/2025
CH010580	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	04/01/2025
CH010580	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	04/01/2025
CH010580	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/01/2025
CH010580	BIOPLUS SPECIALTY PHARMACY, INC	3200 LAKE EMMA RD UNIT 1000		LAKE MARY	FL	32746	04/01/2025
CH010580	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2020
CH010580	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2017
CH010580	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2020
CH010580	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2017
CH010580	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2020
CH010580	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2020
CH010580	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2020
CH010580	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2020
CH010580	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2020
CH010580	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/01/2021
CH010580	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01247	2992 CRANBERRY HWY	EAST WAREHAM	MA	02538	07/01/2020
CH010580	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00518	419 MAIN ST,	WAREHAM	MA	02571	07/01/2020
CH010580	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2020
CH010580	CYSTIC FIBROSIS SERVICES	CYSTIC FIBROSIS SERVICES, INC	10530 JOHN W ELLIOTT DR, STE 200	FRISCO	TX	75033	04/01/2016	08/09/2017
CH010580	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2017
CH010580	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	04/01/2025
CH010580	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/01/2023
CH010580	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/01/2023
CH010580	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/01/2023
CH010580	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/01/2023
CH010580	GENOA HEALTHCARE LLC		530 NORTH MAIN STREET SUITE 6	PROVIDENCE	RI	02904-5762	01/01/2019
CH010580	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	04/01/2019
CH010580	MAXI DRUG SOUTH, LP	RITE AID #10252	711 BROAD ST.	PROVIDENCE	RI	02907	07/01/2016	01/11/2018
CH010580	MAXI DRUG SOUTH, LP	RITE AID #10253	200 ACADEMY AVENUE	PROVIDENCE	RI	02908	10/01/2017	01/11/2018
CH010580	MAXI DRUG SOUTH, LP	RITE AID #10249	456 BRANCH AVENUE	PROVIDENCE	RI	02904	10/01/2017	01/11/2018
CH010580	MAXI DRUG SOUTH, LP.	RITE AID #6727	500 BROAD STREET STE 6	PROVIDENCE	RI	02907	07/01/2016	01/11/2018
CH010580	NKI ENTERPRISES INC	WHITE CROSS PHARMACY	11 BLACKSTONE VALLEY PLACE	LINCOLN	RI	02865	01/01/2020
CH010580	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2025
CH010580	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2022
CH010580	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	10/01/2022
CH010580	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	10/01/2022
CH01058B	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/01/2022
CH010580	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/01/2023
CH010580	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2019
CH010580	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	10/01/2017	04/11/2023
CH010580	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2017
CH010580	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/01/2021
CH010580	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/01/2021
CH010580	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2293	2 DUDLEY STREET SUITE 170	PROVIDENCE	RI	02905	01/27/2023
CH010580	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	04/01/2025
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00212	681 RESERVOIR AVENUE	CRANSTON	RI	02910	04/01/2014
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00994	131 WEBSTER AVENUE	PROVIDENCE	RI	02909	04/01/2014
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04796	960 BROAD STREET	PROVIDENCE	RI	02905	04/01/2014
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00856	400 ADMIRAL STREET	PROVIDENCE	RI	02908	04/01/2017
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02049	PROVIDENCE PLACE MALL, SUITE 1010 39 PROVIDENCE PLACE	PROVIDENCE	RI	02903	04/01/2017
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02347	640 WARREN AVENUE	EAST PROVIDENCE	RI	02914	04/01/2017
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02417	935 MANTON AVENUE	PROVIDENCE	RI	02909	04/01/2017
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00351	1919 MINERAL SPRING AVENUE	NORTH PROVIDENCE	RI	02904	07/01/2020
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04096	309 BROAD ST.	CENTRAL FALLS	RI	02863	07/01/2020
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00729	799 HOPE STREET	PROVIDENCE	RI	02906	07/01/2020
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 5868	1776 BROAD ST.	CRANSTON	RI	02905	07/01/2020
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00642	767 WARWICK AVENUE	WARWICK	RI	02888	07/01/2020
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00733	2400 WARWICK AVE MEADOWBROOK PLAZA	WARWICK	RI	02889	07/01/2020
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00269	583 TAUNTON AVENUE	EAST PROVIDENCE	RI	02914	07/01/2020
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01042	835 NEWPORT AVE.	PAWTUCKET	RI	02861	07/01/2020
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00670	601 SMITHFIELD AVENUE	PAWTUCKET	RI	02860	01/01/2021
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00494	1400 HARTFORD AVENUE	JOHNSTON	RI	02919	01/01/2021
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02234	425 EAST AVENUE	PAWTUCKET	RI	02860	01/01/2021
CH010580	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01075	20 HIGH STREET	PASCOAG	RI	02859	01/01/2021
CH010580	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	04/01/2025
CH010580	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	04/01/2025
CH010580	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH010580	WAL-MART PHARMACY 10-1873	1776 PLAINFIELD PIKE		CRANSTON	RI	02921	07/01/2017
CH010580	WAL-MART PHARMACY 10-2373	840 POST RD		WARWICK	RI	02888	07/01/2021
CH010580	WAL-MART PHARMACY 10-3301	51 SILVER SPRING STREET		PROVIDENCE	RI	02904	07/01/2016
CH010580	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH01058B	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03204	295 ACADEMY AVENUE	PROVIDENCE	RI	02908	04/02/2007
CH01058A	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04145	533 ELMWOOD AVE.	PROVIDENCE	RI	02907	12/04/2006
CH01058C	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04145	533 ELMWOOD AVE.	PROVIDENCE	RI	02907	12/04/2006
CH01058G	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03204	295 ACADEMY AVENUE	PROVIDENCE	RI	02908	04/16/2007
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03468	100 BROAD ST	PAWTUCKET	RI	02860	01/13/2011
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03491	1763 BROAD ST	CRANSTON	RI	02905	01/13/2011
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03703	354 ADMIRAL STREET	PROVIDENCE	RI	02908	01/13/2011
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04145	533 ELMWOOD AVE.	PROVIDENCE	RI	02907	03/09/2011
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10256	1140 N. MAIN ST.	PROVIDENCE	RI	02904-1819	01/13/2011
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10099	333 ATWELLS AVE STE 1	PROVIDENCE	RI	02903	01/13/2011
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03204	295 ACADEMY AVENUE	PROVIDENCE	RI	02908	03/09/2011
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11147	1 POCASSET AVE.	PROVIDENCE	RI	02909-2907	01/13/2011
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02850	1010 PARK AVE	CRANSTON	RI	02910	01/01/2013
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03345	2399 WARWICK AVE.	WARWICK	RI	02889	01/01/2013	06/25/2019
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03704	3336 POST ROAD	WARWICK	RI	02886	01/01/2013	07/18/2019
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03719	25 PUTNAM PIKE	JOHNSTON	RI	02919	01/01/2013
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03737	1074 MINERAL SPRING AVE.	NORTH PROVIDENCE	RI	02904-4104	01/01/2013
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03898	45 CUMBERLAND ST	WOONSOCKET	RI	02895	01/01/2013
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03899	1387 PLAINFIELD ST	JOHNSTON	RI	02919	01/01/2013
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06592	1560 WARWICK AVE	WARWICK	RI	02889-1020	01/01/2013
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #09374	600 WARREN AVE.	EAST PROVIDENCE	RI	02914	01/01/2013	07/17/2019
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10476	1583 ATWOOD AVE.	JOHNSTON	RI	02919	01/01/2013
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #13987	385 COTTAGE ST.	PAWTUCKET	RI	02861-1603	01/01/2013
CH010580	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06850	1103 KEMPTON STREET	NEW BEDFORD	MA	02740-1530	10/01/2017
CH01058D	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04145	533 ELMWOOD AVE.	PROVIDENCE	RI	02907	12/04/2006
CH01058N	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04145	533 ELMWOOD AVE.	PROVIDENCE	RI	02907	04/02/2007
CH010580	WALGREEN EASTERN CO., INC.	WALGREENS #19844	500 BROAD ST STE 6	PROVIDENCE	RI	02907-1367	01/25/2018	02/27/2024
CH010580	WALGREEN EASTERN CO., INC.	RITE AID #10252	711 BROAD ST.	PROVIDENCE	RI	02907	01/25/2018	02/20/2019
CH010580	WALGREEN EASTERN CO., INC.	WALGREENS #18384	456 BRANCH AVE.	PROVIDENCE	RI	02904-2205	01/25/2018	04/11/2023
CH010580	WALGREEN EASTERN CO., INC.	RITE AID #10253	200 ACADEMY AVE.	PROVIDENCE	RI	02908	01/25/2018	02/26/2019
CH01058V	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10256	1140 N. MAIN ST.	PROVIDENCE	RI	02904-1819	01/01/2024
CH01058V	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03703	354 ADMIRAL STREET	PROVIDENCE	RI	02908	01/01/2024
CH01058Q	WALGREEN EASTERN CO., INC.	WALGREENS #19844	500 BROAD ST STE 6	PROVIDENCE	RI	02907-1367	01/01/2024
CH01058G	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11147	1 POCASSET AVE.	PROVIDENCE	RI	02909-2907	01/01/2024
CH01058C	WALGREEN EASTERN CO., INC.	WALGREENS #19844	500 BROAD ST STE 6	PROVIDENCE	RI	02907-1367	01/01/2024
CH01058Z	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11147	1 POCASSET AVE.	PROVIDENCE	RI	02909-2907	01/01/2024
CH01058W	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10256	1140 N. MAIN ST.	PROVIDENCE	RI	02904-1819	01/01/2024
CH01058U	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10256	1140 N. MAIN ST.	PROVIDENCE	RI	02904-1819	01/01/2024
CH01058B	WALGREEN EASTERN CO., INC.	WALGREENS #19844	500 BROAD ST STE 6	PROVIDENCE	RI	02907-1367	01/01/2024
CH01058U	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03703	354 ADMIRAL STREET	PROVIDENCE	RI	02908	01/01/2024
CH01058W	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03703	354 ADMIRAL STREET	PROVIDENCE	RI	02908	01/01/2024
CH010580	WALGREENS #15538	335 PRAIRIE AVE		PROVIDENCE	RI	02905	01/01/2013
CH01058A	WALGREENS #15538	335 PRAIRIE AVE		PROVIDENCE	RI	02905	01/01/2024
CH010580	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	10/01/2023
CH010580	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	06/25/2019
CH010580	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/01/2013	06/25/2019
CH010580	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	01/01/2018
CH010580	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/01/2016
CH010580	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/01/2016	04/07/2023
CH010580	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/01/2016
CH010580	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/01/2016
CH010580	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	01/01/2018
CH010580	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		1/1/2023 12:00:00 AM	2/11/2025 2:29 PM
Details	State	Update	Recertification	Active	To Be Terminated	2/11/2025 2:29 PM
Terminations	Termination Date	Update	Recertification		4/1/2025 12:00:00 AM	2/11/2025 2:29 PM
Terminations	Termination Effective Date	Update	Recertification		2/11/2025 12:00:00 AM	2/11/2025 2:29 PM
Terminations	Termination Reason	Update	Recertification		Business decision by the Covered Entity	2/11/2025 2:29 PM
Details	Last Recertification Date	Update	Recertification	2/6/2023 10:03:01 AM	2/1/2024 2:14:40 PM	2/1/2024 2:14 PM
Details	Last Recertification Date	Update	Recertification	1/31/2022 10:49:08 AM	2/6/2023 10:03:01 AM	2/6/2023 10:03 AM
Details	Last Recertification Date	Update	Recertification	2/9/2021 9:39:15 AM	1/31/2022 10:49:08 AM	1/31/2022 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1053313593 ( )		2/9/2021 9:39 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1053313593	2/9/2021 9:39 AM
Medicaid Billing	NPI: State	Insert	Recertification		RI	2/9/2021 9:39 AM
Details	Last Recertification Date	Update	Recertification	2/3/2020 10:40:51 AM	2/9/2021 9:39:15 AM	2/9/2021 9:39 AM
Details	Last Recertification Date	Update	Recertification	2/4/2019 10:18:39 AM	2/3/2020 10:40:51 AM	2/3/2020 10:40 AM
Details	Last Recertification Date	Update	Recertification	2/8/2018 11:27:59 AM	2/4/2019 10:18:39 AM	2/4/2019 10:18 AM
Contacts	Primary Contact	Update	Recertification	THOMAS, MERRILL CEO PCHC 4014440400-3130	Clark, Garrett CO Providence Community Health Centers 4014440400	2/8/2018 11:27 AM
Details	Last Recertification Date	Update	Recertification	2/7/2017 12:00:00 AM	2/8/2018 11:27:59 AM	2/8/2018 11:27 AM
Contacts	Authorizing Official	Update		THOMAS, MERRILL CEO 4014440400-3130	THOMAS, MERRILL CEO PCHC 4014440400-3130	10/2/2017 3:36 PM
Contacts	Primary Contact	Update		THOMAS, MERRILL CEO 4014440400-3130	THOMAS, MERRILL CEO PCHC 4014440400-3130	10/2/2017 3:36 PM
Contacts	Authorizing Official	Insert			THOMAS, MERRILL CEO 4014440400-3130	8/9/2017 5:01 PM
Contacts	Primary Contact	Insert			THOMAS, MERRILL CEO 4014440400-3130	8/9/2017 5:01 PM
Addresses	Main Address	Insert			325 PUBLIC ST PROVIDENCE, RI 02905-2340	2/10/2017 3:29 PM
Details	Last Recertification Date	Update		3/2/2016 12:00:00 AM	2/7/2017 12:00:00 AM	2/10/2017 3:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	3/2/2016 2:21 PM
Medicaid Billing	Medicaid: Number	Insert			601200231	3/2/2016 2:21 PM
Medicaid Billing	Medicaid: State	Insert			RI	3/2/2016 2:21 PM
Medicaid Billing	NPI: Number	Insert			1053313593	3/2/2016 2:21 PM
Details	Last Recertification Date	Update		3/9/2015 12:00:00 AM	3/2/2016 12:00:00 AM	3/2/2016 2:21 PM
Details	Last Recertification Date	Update		3/13/2014 12:00:00 AM	3/9/2015 12:00:00 AM	3/9/2015 10:28 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/13/2014 12:00:00 AM	3/13/2014 6:12 AM
Details	Entity Name	Update		THE PROVIDENCE COMMUNITY HEALTH CENTERS, INC.	PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE	3/13/2014 6:12 AM
Details	Entity Subname	Update		MET SCHOOL HEALTH CENTER	THE METROPOLITAN SHC	3/13/2014 6:12 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/18/2013 11:15 AM
Details	Entity Subname	Update		MT. PLEASANT HIGH SCHOOL HEALTH CENTER	MET SCHOOL HEALTH CENTER	3/18/2013 11:15 AM
Details	Last Recertification Date	Insert				4/1/2004 12:00 AM
Details	Grant Number	Insert			H80CS00057	4/1/2004 12:00 AM
Details	340B ID	Insert			CH01058J	4/1/2004 12:00 AM
Details	Is Authorizing Official EHB Data	Insert				4/1/2004 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/1/2004 12:00 AM
Details	Medicare Provider Number	Insert				4/1/2004 12:00 AM
Details	Entity Name	Insert			THE PROVIDENCE COMMUNITY HEALTH CENTERS, INC.	4/1/2004 12:00 AM
Details	Program Code	Insert			CH	4/1/2004 12:00 AM
Details	Entity Subname	Insert			MT. PLEASANT HIGH SCHOOL HEALTH CENTER	4/1/2004 12:00 AM
Dates	Participating Approval Date	Insert			3/25/2004 3:34:27 PM	4/1/2004 12:00 AM
Details	State	Insert			Active	4/1/2004 12:00 AM
Dates	Registration Date	Insert			4/1/2004 12:00:00 AM	4/1/2004 12:00 AM
Dates	Signed By Date	Insert				4/1/2004 12:00 AM
Dates	Start Date	Insert			4/1/2004 12:00:00 AM	4/1/2004 12:00 AM
Terminations	Termination Comments	Insert				4/1/2004 12:00 AM
Terminations	Termination Date	Insert				4/1/2004 12:00 AM
Terminations	Termination Effective Date	Insert				4/1/2004 12:00 AM
Terminations	Termination Reason	Insert				4/1/2004 12:00 AM
Details	Comments Public	Insert			NEW SITE 04/01/2004	4/1/2004 12:00 AM

340B Drug Pricing Program Database